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Quinn B, Laurent S, Dargan S, Lapuente M, Lüftner D, Drudge-Coates L, Palma MD, Lago LD, Flynn J, Panter C, Seesaghur A. Managing Advanced Cancer Pain Together (MACPT) conversation tool: an evaluation of use in clinical practice. Pain Manag 2021; 12:435-446. [PMID: 34866400 DOI: 10.2217/pmt-2021-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate use of the 'Managing Advanced Cancer Pain Together' conversation tool between individuals with advanced cancer and healthcare professionals (HCPs) during routine consultations. Methods: Twenty-one patients and six HCPs completed questionnaires before and after use of the tool (at their routine consultation 1 and consecutive consultation 2, respectively). Results: Patients and HCPs were satisfied with communication during both consultations. When using the tool, patients most frequently selected physical pain descriptors (95.2%), followed by emotional (81.0%), social (28.6%) and spiritual (28.6%) descriptors. Patients found the tool useful, stating that it helped them describe their pain. HCPs considered the tool difficult to incorporate into consultations. Conclusion: The study highlighted the need to consider the various aspects of cancer pain.
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Affiliation(s)
| | | | - Susan Dargan
- Ashford & St Peter's Hospital NHS Foundation Trust, Surrey, TW15 3AA, UK
| | | | | | | | - Mario Di Palma
- Hôpital Américain de Paris, Neuilly-sur-Seine, 92200, France
| | | | - Jessica Flynn
- Adelphi Values, Patient-Centered Outcomes, Cheshire, SK10 5JB, UK
| | - Charlotte Panter
- Adelphi Values, Patient-Centered Outcomes, Cheshire, SK10 5JB, UK
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Brown JE, Handforth C, Compston JE, Cross W, Parr N, Selby P, Wood S, Drudge-Coates L, Walsh JS, Mitchell C, Collinson FJ, Coleman RE, James N, Francis R, Reid DM, McCloskey E. Guidance for the assessment and management of prostate cancer treatment-induced bone loss. A consensus position statement from an expert group. J Bone Oncol 2020; 25:100311. [PMID: 32995252 PMCID: PMC7516275 DOI: 10.1016/j.jbo.2020.100311] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 02/08/2023] Open
Abstract
Bone health should be prioritised when men with prostate cancer start long-term ADT. Assessment by FRAX (±bone mineral density) identifies those at highest risk of fracture. Treatment can minimise skeletal complications and reduce morbidity and mortality.
Context and objective Incidence of prostate cancer (PC) is increasing, but androgen deprivation therapy (ADT) and other therapies are substantially improving survival. In this context, careful consideration of skeletal health is required to reduce the risk of treatment-related fragility fractures and their associated morbidity and mortality. This risk is currently not well-managed. ADT causes significant loss of bone mineral density (BMD). In the metastatic setting, systemic treatments (e.g. chemotherapy, abiraterone, enzalutamide) are used alongside ADT and may require concomitant glucocorticoids. Both ADT and glucocorticoids pose significant challenges to skeletal health in a population of patients already likely to have ongoing age-related bone loss and/or comorbid conditions. Current PC guidelines lack specific recommendations for optimising bone health. This guidance presents evidence for assessment and management of bone health in this population, with specific recommendations for clinical practitioners in day-to-day PC management. Methods Structured meetings of key opinion leaders were integrated with a systematic literature review. Input and endorsement was sought from patients, nursing representatives and specialist societies. Summary of guidance All men starting or continuing long-term ADT should receive lifestyle advice regarding bone health. Calcium/vitamin D supplementation should be offered if required. Fracture risk should be calculated (using the FRAX® tool), with BMD assessment included where feasible. BMD should always be assessed where fracture risk calculated using FRAX® alone is close to the intervention threshold. Intervention should be provided if indicated by local or national guidelines e.g. UK National Osteoporosis Guideline Group (NOGG) thresholds. Men requiring bone protection therapy should be further assessed (e.g. renal function), with referral to specialist centres if available and offered appropriate treatment to reduce fracture risk. Those near to, but below an intervention threshold, and patients going on to additional systemic therapies (particularly those requiring glucocorticoids), should have FRAX® (including BMD) repeated after 12–18 months. Patient summary Modern treatments for prostate cancer have led to significant improvements in survival and quality of life. However, some of these treatments may lead to weakening of patient’s bones with risk of fracture and it is therefore important to monitor patients’ bone health and provide bone protection where needed. This paper provides specific guidance to clinical teams, based on the most recent research evidence, to ensure optimal bone health in their patients.
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Affiliation(s)
- Janet E Brown
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | - Catherine Handforth
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | | | - William Cross
- Department of Urology, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - Nigel Parr
- Department of Urology, Wirral University Hospitals NHS Foundation Trust, United Kingdom
| | - Peter Selby
- Faculty of Medicine and Health, University of Manchester, United Kingdom
| | - Steven Wood
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | | | - Jennifer S Walsh
- Academic Unit of Bone Metabolism, University of Sheffield, United Kingdom
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, University of Sheffield, United Kingdom
| | - Fiona J Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Robert E Coleman
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | - Nicholas James
- Institute of Cancer and Genomic Sciences, University of Birmingham, United Kingdom
| | - Roger Francis
- Institute of Cellular Medicine, University of Newcastle, United Kingdom
| | - David M Reid
- Institute of Medical Sciences, University of Aberdeen, United Kingdom
| | - Eugene McCloskey
- Academic Unit of Bone Metabolism, University of Sheffield, United Kingdom
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Drudge-Coates L, Delacruz A, Gledhill R, Goh P, Tomlinson B. Metastatic Prostate Cancer: An Update on Treatments and a Review of Patient Symptom Management. Clin J Oncol Nurs 2020; 24:369-378. [DOI: 10.1188/20.cjon.369-378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Drudge-Coates L, van Muilekom E, de la Torre-Montero JC, Leonard K, van Oostwaard M, Niepel D, Jensen BT. Management of bone health in patients with cancer: a survey of specialist nurses. Support Care Cancer 2020; 28:1151-1162. [PMID: 31203509 PMCID: PMC6989658 DOI: 10.1007/s00520-019-04858-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with cancer can experience bone metastases and/or cancer treatment-induced bone loss (CTIBL), and the resulting bone complications place burdens on patients and healthcare provision. Management of bone complications is becoming increasingly important as cancer survival rates improve. Advances in specialist oncology nursing practice benefit patients through better management of their bone health, which may improve quality of life and survival. METHODS An anonymised online quantitative survey asked specialist oncology nurses about factors affecting their provision of support in the management of bone metastases and CTIBL. RESULTS Of 283 participants, most stated that they worked in Europe, and 69.3% had at least 8 years of experience in oncology. The most common areas of specialisation were medical oncology, breast cancer and/or palliative care (20.8-50.9%). Awareness of bone loss prevention measures varied (from 34.3% for alcohol intake to 77.4% for adequate calcium intake), and awareness of hip fracture risk factors varied (from 28.6% for rheumatoid arthritis to 74.6% for age > 65 years). Approximately one-third reported a high level of confidence in managing bone metastases (39.9%) and CTIBL (33.2%). International or institution guidelines were used by approximately 50% of participants. Common barriers to better specialist care and treatment were reported to be lack of training, funding, knowledge or professional development. CONCLUSION This work is the first quantitative analysis of reports from specialist oncology nurses about the management of bone metastases and CTIBL. It indicates the need for new nursing education initiatives with a focus on bone health management.
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Affiliation(s)
- Lawrence Drudge-Coates
- Department of Urology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Erik van Muilekom
- Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Kay Leonard
- St Luke's Radiation Oncology Centre at St James's Hospital, Dublin, Ireland
| | | | | | - Bente Thoft Jensen
- Aarhus University Hospital and Centre of Research in Rehabilitation, Aarhus University, Aarhus, Denmark
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Drudge-Coates L, Khati V, Ballesteros R, Martyn-Hemphill C, Brown C, Green J, Challacombe B, Muir G. A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. Ecancermedicalscience 2019; 13:994. [PMID: 32010218 PMCID: PMC6974368 DOI: 10.3332/ecancer.2019.994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate the outcomes from a Urology Nurse Practitioner (UNP)-led service for the initial assessment and diagnostic decision making and for suspected prostate cancer referrals. Methods Using a modified Delphi analysis approach, a panel of Urological Prostate Cancer specialists were asked to review the UNP management plans of a convenience sample of 60 randomly selected patient cases – between June 2012 and June 2015. The panel was required to establish consensus or identify divergence of clinical practice, based on five key statements. In addition, cost analysis, waiting time and patient satisfaction evaluation were made regarding the nurse-led service. Results In 87% (52/60 cases), consensus was reached by the panel that the UNP management plan was entirely appropriate and in only two cases was there discordance, where the panel felt that the management plan by the UNP was inappropriate with errors potentially and significantly affecting the patient. Over the 3 years, a modest cost saving of £11,500.38 was realised, which due to increased referrals has now realised in 1 year (2017/18) a saving of £11,335.50. Compared to the previous physician-led service, waiting times for patient appointment fell by 52% over the 3-year period; 57/63 (90%) patients reported being satisfied with seeing a UNP instead of a doctor for their first appointment; 60/63 (95%) reported that, following the initial hospital visit with the UNP, they had a clear understanding of what the next steps were in their assessment. Overall, 54/63 (86%) were ‘very satisfied’ with the UNP-led service. Conclusion Our study demonstrates that a UNP approach to the assessment and management of suspected prostate cancer referrals provides an effective approach to care in an ever-demanding healthcare arena. Through a supported training programme, urology nurses can deliver a high standard of service.
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Affiliation(s)
| | - Vitra Khati
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | - Randolph Ballesteros
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | | | - Christian Brown
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | - James Green
- Department of Urology, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Gordon Muir
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
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6
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Drudge-Coates L, Oh WK, Tombal B, Delacruz A, Tomlinson B, Ripley AV, Mastris K, O'Sullivan JM, Shore ND. Recognizing Symptom Burden in Advanced Prostate Cancer: A Global Patient and Caregiver Survey. Clin Genitourin Cancer 2017; 16:e411-e419. [PMID: 29111175 DOI: 10.1016/j.clgc.2017.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/21/2017] [Accepted: 09/24/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bone metastases in men with prostate cancer are often initially asymptomatic, resulting in delayed identification, diagnosis, and appropriate treatment. To assess how patients with advanced prostate cancer (aPC) communicate symptoms to health care providers, an international patient survey was conducted. METHODS An online and phone survey was conducted by Harris Poll in 11 countries (Brazil, France, Germany, Japan, Italy, Netherlands, Singapore, Spain, Taiwan, United Kingdom, United States) from February 12 to October 27, 2015, in men with aPC (ie, those who reported as having PC beyond the prostate [metastatic]) and their caregivers. Cell weighting was used to ensure equal weight of data across countries. Percentages are based on weighted n values. RESULTS A total of 927 men with aPC (weighted n = 664) and 400 caregivers completed the survey. Most commonly reported symptoms were fatigue (73%), urinary symptoms (63%), sexual function symptoms (62%), and bone pain (52%). Of 568 patients with bone metastases (weighted n = 421), most (73%) noticed pain before receiving a diagnosis of metastatic PC. Most patients with aPC (56%) were uncertain if their pain was cancer related, 55% felt they had to live with daily pain, 45% sometimes ignored pain, and 39% had difficulty talking about pain. Patients who had a caregiver were more likely than those without to discuss pain at every visit (45% vs. 32%, P < .05). CONCLUSIONS Disease symptoms in aPC are often underrecognized. Tools encouraging effective communication among patients, caregivers, and health care providers on early symptom reporting may lead to enhanced symptom and disease management.
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Affiliation(s)
| | - William K Oh
- Tisch Cancer Institute-Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bertrand Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | | | | | - Ken Mastris
- Europa Uomo, The European Prostate Cancer Coalition, Essex, UK
| | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC
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Oh WK, Tombal BF, Delacruz A, Tomlinson B, Vella Ripley A, Drudge-Coates L, Mastris K, O'Sullivan JM, Shore ND. Recognizing symptom burden in advanced prostate cancer: A global patient and caregiver survey. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- William K. Oh
- Division of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, NY
| | - Bertrand F. Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | - Lawrence Drudge-Coates
- Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ken Mastris
- Europa UoMo, The European Prostate Cancer Coalition, Essex, United Kingdom
| | - Joe M. O'Sullivan
- Queen's University School of Medicine / Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, United Kingdom
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8
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Turner B, Drudge-Coates L, Ali S, Pati J, Nargund V, Ali E, Cheng L, Wells P. Osteonecrosis of the Jaw in Patients Receiving Bone-Targeted Therapies: An Overview--Part I. Urol Nurs 2016; 36:111-154. [PMID: 27501591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Urologic patients receiving bone-targeted therapies are at risk of developing osteonecrosis of the jaw (ONJ). ONJ has historically been associated with bisphosphonate therapy. More recently, RANK-Ligand inhibitors (denosumab) have also been used to reduce the risk of skeletal-related events in patients who have advanced cancers with bone metastases. More than 65% of men with metastatic prostate cancer and nearly 75% of women with metastatic breast cancer are affected by bone metastases. The literature has described ONJ associated with bisphosphonate therapy as bisphosphonate-related osteonecrosis of the jaw (BRONJ). However, with evidence also linking the use of RANK-Ligand inhibitors with osteonecrosis of the jaw, we advocate use of the term "anti-bone resorption therapy-related osteonecrosis of the jaw" (ABRT-ONJ). The term "medication-related osteonecrosis of the jaw" (MRONJ) is now becoming more widespread. There is not a universally accepted definition of ABRT-ONJ, which may have hindered recognition and reporting of the condition. In Part I of this article, a review of current knowledge around the etiology of ABRT-ONJ and incidence data are provided. In Part II, we provide an audit of ONJ in a nurse consultant-led bone support clinic. In the article, we refer to zoledronic acid because this is the bisphosphonate of choice for use in men with prostate cancer in the United Kingdom.
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Turner B, Drudge-Coates L. How to perform transrectal ultrasound and prostate biopsy. Nurs Stand 2016; 30:36-9. [PMID: 27050013 DOI: 10.7748/ns.30.32.36.s42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bruce Turner
- Homerton University Hospital NHS Foundation Trust.,Barts Health NHS Trust, London, England
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10
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Turner B, Ali S, Drudge-Coates L, Pati J, Nargund V, Wells P. Skeletal Health Part 1: Overview Of Bone Health and Management In the Cancer Setting. Urol Nurs 2016; 36:17-26. [PMID: 27093759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cancer-induced bone disease and cancer therapy-induced bone loss are significant skeletal problems related to the treatment for urological and other cancers. Our team of specialists and nurse practitioners developed a nurse practitioner-led Bone Support Clinic for urologic cancer patients at a university hospital in London, England, United Kingdom, to address this issue. The clinic has been well-accepted, has made a positive impact on the patient journey, helps to ensure continuity of care, and highlights patients who require assessment or treatment for impending skeletal-related events in a timely fashion. This article has been divided into two parts for improved readability.
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Turner B, Ali S, Drudge-Coates L, Pati J, Nargund V, Wells P. Skeletal Health Part 2: Development of a Nurse Practitioner Bone Support Clinic for Urologic Patients. Urol Nurs 2016; 36:22-26. [PMID: 27093760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Part 1 of this article highlighted the potential negative effects of cancer on the skeleton and provided an overview of available treatment options. Part 2 presents a nurse practitioner-led Bone Support Clinic, which was developed for patients with cancer-induced bone disease and cancer therapy-induced bone loss. This clinic, started in 2011 in a university medical center urology/oncology outpatient center in London, England, United Kingdom, has been a collaborative effort among a multidisciplinary team of doctors, nurse practitioners and nurses. Patients have responded positively to the improved continuity of care, and we have been able to assess and treat impending skeletal-related events in a more timely manner The needs of our patient population and problems with the existing service are reviewed, and the importance of a multidisciplinary approach to these problems is discussed. Initiation of a nurse practitioner-led Bone Support Clinic and the impact of timely response to the effects of cancer and cancer therapies on the skeletal system are outlined and offered as a model.
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Valdagni R, Van Poppel H, Aitchison M, Albers P, Berthold D, Bossi A, Brausi M, Denis L, Drudge-Coates L, Feick G, Hoyer M, Hummel H, Mirone V, Müller S, Parker C, Sternberg C, Tombal B, van Muilekom E, Watson M, Wesselmann S, Costa A. Prostate cancer unit initiative in europe: a consensus on standards of care. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Faithfull S, Lemanska A, Aslet P, Bhatt N, Coe J, Drudge-Coates L, Feneley M, Glynn-Jones R, Kirby M, Langley S, McNicholas T, Newman J, Smith CC, Sahai A, Trueman E, Payne H. Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies. Int J Clin Pract 2015; 69:1184-208. [PMID: 26292988 PMCID: PMC5042099 DOI: 10.1111/ijcp.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIM To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context. METHODS PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK. RESULTS Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment. CONCLUSION Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.
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Affiliation(s)
- S Faithfull
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - A Lemanska
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - P Aslet
- Department of Urology, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - N Bhatt
- Sutton & Merton Community Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Coe
- University College Hospital, London, UK
| | | | - M Feneley
- University College Hospital, London, UK
| | | | - M Kirby
- Faculty of Health & Human Sciences, Centre for Research in Primary & Community Care (CRIPACC), University of Hertfordshire, Hertfordshire, UK
| | - S Langley
- The Royal Surrey County Hospital, Guildford, UK
| | | | - J Newman
- Oxford University Hospital, Oxford, UK
| | - C C Smith
- School of Health and Social Care, Bournemouth University, Dorset, UK
| | - A Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - E Trueman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College Hospital, London, UK
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14
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Valdagni R, Van Poppel H, Aitchison M, Albers P, Berthold D, Bossi A, Brausi M, Denis L, Drudge-Coates L, De Santis M, Feick G, Harrison C, Haustermans K, Hollywood D, Hoyer M, Hummel H, Mason M, Mirone V, Müller SC, Parker C, Saghatchian M, Sternberg CN, Tombal B, van Muilekom E, Watson M, Wesselmann S, Wiegel T, Magnani T, Costa A. Prostate Cancer Unit Initiative in Europe: A position paper by the European School of Oncology. Crit Rev Oncol Hematol 2015; 95:133-43. [PMID: 26092320 DOI: 10.1016/j.critrevonc.2015.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/04/2015] [Accepted: 05/26/2015] [Indexed: 02/06/2023] Open
Abstract
The Prostate Cancer Programme of the European School of Oncology developed the concept of specialised interdisciplinary and multiprofessional prostate cancer care to be formalized in Prostate Cancer Units (PCU). After the publication in 2011 of the collaborative article "The Requirements of a Specialist Prostate Cancer Unit: A Discussion Paper from the European School of Oncology", in 2012 the PCU Initiative in Europe was launched. A multiprofessional Task Force of internationally recognized opinion leaders, among whom representatives of scientific societies, and patient advocates gathered to set standards for quality comprehensive prostate cancer care and designate care pathways in PCUs. The result was a consensus on 40 mandatory and recommended standards and items, covering several macro-areas, from general requirements to personnel to organization and case management. This position paper describes the relevant, feasible and applicable core criteria for defining PCUs in most European countries delivered by PCU Initiative in Europe Task Force.
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Affiliation(s)
- Riccardo Valdagni
- European School of Oncology, Milan, Italy; Prostate Cancer Programme, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Hendrik Van Poppel
- Dept of Urology, University Hospital of the Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Peter Albers
- Dept of Urology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Dominik Berthold
- Centre Polidisciplinaire d'Oncologie, Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Alberto Bossi
- Dept of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Maurizio Brausi
- Dept of Urology, Ausl Modena, Nuovo Ospedale Civile-S. Agostino Estense, Modena, Italy
| | - Louis Denis
- Europa Uomo, Antwerp, Belgium; Oncological Centre, Antwerp, Belgium
| | | | - Maria De Santis
- University of Warwick, Cancer Research Unit, Coventry, UK; Queen Elizabeth Hospital-Cancer Centre, Birmingham, UK
| | - Günther Feick
- Europa Uomo, Antwerp, Belgium; Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | - Chris Harrison
- Greater Manchester Strategic Health Authority, Manchester, UK
| | - Karin Haustermans
- Dept. of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Donal Hollywood
- Urologic and Radiation Oncology, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Morton Hoyer
- Dept of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Henk Hummel
- Integraal Kankercentrum Nederland (IKNL), Comprehensive Cancer Centre Netherlands, Utrecht, The Netherlands
| | - Malcolm Mason
- Dept of Oncology and Palliative Medicine, Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Vincenzo Mirone
- Dept of Urology, University of Naples Federico II, Naples, Italy
| | | | - Chris Parker
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Cora N Sternberg
- Dept of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - Bertrand Tombal
- Dept of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Erik van Muilekom
- Dept of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maggie Watson
- Research Department of Clinical, Educational and Health Psychology, University College, London, UK
| | | | - Thomas Wiegel
- Dept of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Tiziana Magnani
- Prostate Cancer Programme, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Drudge-Coates L, Khati V, Brown C. 60 Nurse led assessment of urgent GP suspected prostate cancer referrals: evaluation of a new model of care. Eur J Oncol Nurs 2014. [DOI: 10.1016/s1462-3889(14)70079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tombal B, Diel I, Drudge-Coates L, Haynes I, Brodowicz T. Bone metastases: Are we failing our patients? J Bone Oncol 2014; 3:37-9. [PMID: 26909295 PMCID: PMC4723610 DOI: 10.1016/j.jbo.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 12/02/2022] Open
Affiliation(s)
- B Tombal
- Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, B-1200 Brussels, Belgium
| | - I Diel
- CGG-Klinik Mannheim, Gynäkologischer Onkologe, Quadrat P7, 16-18, 68161 Mannheim, Germany
| | - L Drudge-Coates
- Department of Urology, King׳s College Hospital NHS Foundation Trust, London, UK
| | | | - T Brodowicz
- Comprehensive Cancer Center - Muscoloskeletal Tumors, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria
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Abstract
Prostate cancer is linked to the male sex hormone testosterone. In advanced disease, blocking the production of testosterone using androgen deprivation therapy causes regression of prostate cancer and minimises or prevents symptoms associated with the disease. Luteinising hormone-releasing hormone agonists are commonly used in the management of prostate cancer, however less is known about the role of the newer gonadotrophin-releasing hormone (GnRH) antagonists. This article focuses on the differences between the two treatments and provides nurses with the knowledge to explain the use of GnRH antagonists to patients and administer this therapy effectively.
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Affiliation(s)
- B Turner
- Homerton University Hospital, London and Barts Health Hospitals, London
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Drudge-Coates L, Turner B. Schistosomiasis-an endemic parasitic waterborne disease. Br J Nurs 2013; 22:S10-S14. [PMID: 23752571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Schistosomiasis (or bilharzia) is a chronic waterborne disease caused by parasitic worms or schistosoma in the tropics and sub tropics. Five main species exist, and common to all is its transmission to humans as a result of exposure to infested fresh water, into which the cercariae of the parasite are released by freshwater snails. With the rise of tourism and travel, more people are travelling to countries where schistosomiasis is a risk. Schistosoma haematobium is responsible for urogenital schistosomiasis, in which manifestations range from acute hypersensitivity reactions to bladder disease in the detection of which the nurse cystoscopist can have a significant role. Treatment is highly effective, and the diagnosis should be considered in individuals with possible clinical illness who have travelled to or lived in endemic areas.
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Abstract
This article aims to provide the reader with an overview of penile cancer. The focus is on clinical and medical aspects to help nurses understand incidence, aetiology, diagnosis and treatment, to enable them educate and support patients affected by this disease. Psychological support of patients and their partners is also emphasised as the effects of penile cancer can be significant.
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Affiliation(s)
- Bruce Turner
- Department of Urology, Homerton University Hospital, London.
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Abstract
A diagnosis of bone metastases may be devastating for patients with cancer because it suggests that the cancer is incurable and that patients are at increased risk of developing skeletal-related events. The optimal goal for these patients should be to maintain quality of life. Nurses have an important role in the care of patients with cancer-induced bone disease and need to have a good understanding of the effects of bone metastases to ensure prompt management of this condition.
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Carmona Echeverria LM, Drudge-Coates L, Wilkins CJ, Muir GH. Bone scan is of doubtful value as a first staging test in the primary presentation of prostate cancer. ISRN Oncol 2012; 2012:585017. [PMID: 23209943 PMCID: PMC3503315 DOI: 10.5402/2012/585017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 09/24/2012] [Indexed: 11/23/2022]
Abstract
Purpose. To determine whether axial MR imaging could replace bone scan as the primary staging test in newly diagnosed CaP. Material and Methods. We reviewed retrospectively all bone scans (n = 1201) performed in newly diagnosed CaP patients from 2000 to 2010 in a single tertiary academic center. We recorded patient age, ethnicity, PSA at diagnosis, TNM stage, Gleason score, alkaline phosphatase, bone scan results and axial imaging if available. Results. Mean patient age was 72 years (41–96), mean PSA and alkaline phosphatase were 268.9 ng/mL and 166 IU/L, respectively. Patients were divided in four groups according to possible bony metastases on bone scan. Group 1: Negative, no metastases demonstrated. Group 2: Positive, metastases only in pelvis and/or lumbar spine. Group 3: Positive, widespread metastases including pelvis and lumbar spine. Group 4: Positive, distant metastases without pelvic or lumbar spine abnormalities. Group 4 patients were analyzed in detail, two had possible disease that was detected only outside the pelvic and lumbar spine, unfortunately follow up images were insufficient to confirm the nature of the lesions. Conclusions. Although bone scan is a useful investigation to confirm and monitor metastasic CaP, our data suggests that axial MR imaging is an adequate primary staging study in untreated disease. Bone scan is unnecessary if CT or MRI of the pelvis and abdomen are clear of metastases.
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Affiliation(s)
- Lina M Carmona Echeverria
- Department of Urology, King's College Hospital, 2nd floor Hambleden Wing, Denmark Hill, London SE19 2BY, UK
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22
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Drudge-Coates L, Turner B. Prostate cancer overview. Part 2: metastatic prostate cancer. Br J Nurs 2012; 21:S23-S28. [PMID: 23123814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Advances in diagnosis mean that prostate cancer can be detected in the early stages, when options such as surgery and radiotherapy offer curative approaches and active surveillance is appropriate. However, advanced or metastatic disease continues to challenge medical management, which offers only palliative approaches. With such a prognosis, effective treatment of metastatic and metastatic castrate-resistant prostate cancer (mCRPC) is an important element of the management of these patients. The second article of this two-part series focuses on the main management approaches, emerging therapies and nursing roles.
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Drudge-Coates L, Turner B. Bone micro-environment in prostate cancer: impact, treatment and implications for nursing practice. International Journal of Urological Nursing 2012. [DOI: 10.1111/j.1749-771x.2012.01148.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Drudge-Coates L, Turner B. Prostate cancer overview. Part 1: non-metastatic disease. Br J Nurs 2012; 21:S23-S28. [PMID: 22690411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Prostate cancer is now recognised as one of the most important medical problems facing the male population, with additional factors such as age, race and familial history amplifying the risk of disease. Part 1 of this two-part article, discusses and provides an overview of the key risk factors, through to diagnosis and management of non-metastatic disease. With the current changing dynamics in healthcare provision both in hospitals and the community setting, the articles aims to inform the wider nursing arena of the key issues that may be raised by men seeking advice and intervention both before and following treatment.
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Affiliation(s)
| | - Bruce Turner
- Homerton University Hospital NHS Foundation Trust and Whipps Cross University Hospital NHS Trust, London
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Abstract
Prostate cancer is the most common cancer in men and is recognised as a significant health problem. Treatment of advanced or metastatic prostate cancer is challenging, and support and care should be tailored to meet the individual's needs. This article focuses on the pharmacological management of metastatic prostate cancer and the nurse's role in providing patients with information about the disease. It is hoped that this article will be used as a resource to improve patient care.
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Affiliation(s)
- Bruce Turner
- Department of Urology, Homerton University Hospital, London.
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Carmona L, Muir G, Drudge-Coates L. MP-16.13 Bone Scan Should no Longer Be the First Staging Test in Prostate Cancer. Urology 2011. [DOI: 10.1016/j.urology.2011.07.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carmona L, Muir G, Drudge-Coates L. 7063 POSTER Bone Scan is of Doubtful Value as a First Staging Test in Prostate Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Turner B, Drudge-Coates L, Pati J. ‘Nurse: My back hurts!’: case study review of Degarelix in metastatic prostate cancer. International Journal of Urological Nursing 2011. [DOI: 10.1111/j.1749-771x.2011.01109.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burbridge S, Thillai K, Tang C, Garcia-Imhof A, Drudge-Coates L, Rudman SM, Kinsella J, Cahill D, Kooiman G, Hughes S, Harper P, Chowdhury S. Health professional awareness of treatment-related bone loss in prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Development of bone metastases in patients with advanced cancer is associated with skeletal-related events (SREs) such as pathologic fractures, spinal cord compression, the requirement for surgery or palliative radiotherapy to bone, and hypercalcemia of malignancy. Skeletal morbidity may reduce patient mobility, limit functional independence, and impair quality of life (QOL). Proactive management of new or worsening bone pain or motor impairment is crucial because of the potential for rapid progression of symptoms. Administration of bisphosphonate therapy as a monthly infusion to patients with bone metastases prevents or delays the onset and reduces the frequency of SREs and provides clinically meaningful improvements in bone pain and QOL. In addition to administration of therapy, the monthly infusion visit allows a dedicated team of healthcare professionals to regularly assess SREs, response to therapy, adverse events (AEs), QOL, and adherence to oral medications and supplements. The continuity of care that occurs during the monthly infusion visit provides oncology nurses with an opportunity to educate patients about effective strategies to manage SREs and AEs. In addition, regular interaction provides oncology nurses with an opportunity to recognize and proactively address subtle changes in the patients' medical condition. Using a multidisciplinary medical team also eliminates barriers between the various healthcare professionals involved in patient management. Consequently, the monthly infusion visit can result in effective patient management and improved clinical outcomes in patients with malignant bone disease.
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Affiliation(s)
- Lawrence Drudge-Coates
- Correspondence: Lawrence Drudge-Coates, Urological Oncology Clinical Nurse Specialist and Honorary Lecturer, Department of Urology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom, Tel +44 020 3299 4352, Fax +44 020 3299 3993, Email
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Valdagni R, Albers P, Bangma C, Drudge-Coates L, Magnani T, Moynihan C, Parker C, Redmond K, Sternberg CN, Denis L, Costa A. The requirements of a specialist Prostate Cancer Unit: a discussion paper from the European School of Oncology. Eur J Cancer 2010; 47:1-7. [PMID: 21126868 DOI: 10.1016/j.ejca.2010.10.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 10/26/2010] [Accepted: 10/29/2010] [Indexed: 11/27/2022]
Abstract
The widely recognised benefits of a multidisciplinary approach to treating cancer may be particularly important in prostate cancer, where there are so many treatment options to choose from. It offers patients the best chance of receiving high-quality medical procedures administered by a team of specialists in prostate disease, which is able to tailor treatment and observational strategies to their needs, and ensure access to specialist counselling, supportive care and rehabilitation. This article proposes Prostate Cancer Units as the most suitable structures for organising specialist multidisciplinary care for patients at all stages, from newly diagnosed to advanced disease, including preventing and managing the main complications, whether physical, emotional or psychological, arising from the disease and its treatment. Following the German example with prostate cancer, the British example with urological malignancies and the European breast cancer units, this article proposes general recommendations and mandatory requirements for Prostate Cancer Units, with a view to laying the basis for a network of certified units across Europe. Such a network could help improve standards of care throughout the region, providing patients, practitioners and health authorities with a means of identifying high-quality units and providing a system of quality control and audit. The article is intended as a contribution to the debate within the European uro-oncologic community on the best way to organise prostate cancer care.
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Drudge-Coates L, Chowdhury S. A solitary bone metastasis from renal cell carcinoma. International Journal of Urological Nursing 2010. [DOI: 10.1111/j.1749-771x.2010.01105.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Drudge-Coates L. The Skeletal Care Academy -‘being bold for bone’. International Journal of Urological Nursing 2010. [DOI: 10.1111/j.1749-771x.2010.01102.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Drudge-Coates L, Khati V. Anything to declare sir? Case study review of schistosomiasis haematobium infection. International Journal of Urological Nursing 2009. [DOI: 10.1111/j.1749-771x.2009.01061.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Drudge-Coates L, Roberts J, Thompson P. Gynaecomastia: a case study review of the effect of hormone therapy in the management of prostate cancer. International Journal of Urological Nursing 2008. [DOI: 10.1111/j.1749-771x.2008.00065.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Drudge-Coates L, Thompson P, Muir G. UP.18: Burden of Bone Metastases From Renal Cell Carcinoma: Zoledronic Acid and Functional Independence. Urology 2008. [DOI: 10.1016/j.urology.2008.08.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Malignant spinal cord compression (MSCC) is a particularly challenging area of cancer care where early diagnosis and expert multidisciplinary care and rehabilitation are paramount in optimising quality of life for the affected individual. The effects of MSCC can range from minor sensory, motor and autonomic changes to severe pain, and complete paralysis that significantly affects the remainder of a patient's quality of life. When caught early, the symptoms of MSCC can be prevented, minimised or possibly reversed. However, failure to recognise the condition and its serious nature, together with limited awareness of the importance of early referral for treatment, can result in irreversible paralysis. Therefore, it is essential that nurses providing clinical care for these at-risk patients are able to identify early symptoms, and undertake a thorough patient history and examination; educating the patient and their family about the signs and symptoms of MSCC that need to be reported as soon as they occur.
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47
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Abstract
Metastatic prostate cancer represents an incurable progression of the disease that accounts for the vast majority of disease related mortality and is associated with significant skeletal morbidity with events including bone pain, fractures and spinal cord compression. This article provides an overview of the bone disease in this patient group, with a specific focus on the role of bisphosphonate use, in addressing quality of life issues. Key clinical trial data relating to bisphosphonates is presented and discussed, culminating in key management guidelines.
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48
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Abstract
This article discusses the use of hormone therapy for the treatment of prostate cancer, the most common male cancer. Key to managing this disease is understanding the processes responsible for maintaining prostate growth and hormonal homeostasis in male development. The individual mechanisms of action are outlined and demonstrated for each type of treatment, alongside the effects of these treatments. Each therapeutic option is discussed in conjunction with current key research findings and implications for practice are outlined.
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49
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Abstract
OBJECTIVE Nurse-led prostate clinics (NPCs) have proved to be a highly effective method of assessing patients with lower urinary tract symptoms (LUTS) and most urology units now run such clinics. However, it was not known whether they are cost-effective and this analysis ansWers that question. PATIENTS AND METHODS During one year, a trained urology nurse assessed 1,080 patients in our NPC following GP referral using a standard pro forma. Costs included those incurred for the salary of a grade D nurse at 30 min per patient, all investigations, indirect charges and overheads. This was compared to the cost of seeing all patients in clinic directly, either by a consultant, staff grade urologist or registrar. Of these 1,080 patients, 350 were sent back to their GPs after NPC assessment. RESULTS The NPC cost of 44.25 pounds per patient compared favourably with an average medical out-patient clinic cost of 50.46 pounds per patient, yielding an actual annual saving of 6,706.80 pounds. Since a third of the patients assessed in the NPC were sent directly back to primary care, saving the cost of a medical follow-up appointment, the true savings in secondary care were 17,661.00 pounds (50.46 x 350pounds), giving a total annual saving of 24,367.80 pounds. CONCLUSIONS A nurse-led shared-care prostate clinic is a cost effective, thorough and speedy method of assessing men presenting with suspected bladder outflow obstruction. The approach used has a wider generic, cost-benefit potential for the NHS.
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Affiliation(s)
- P Dasgupta
- Department of Urology, Colchester General Hospital, Essex, UK
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